title: The influence of race on end-of-life choices following a counselor-based palliative consultation.
abstract: Black Americans are more likely than whites to choose aggressive medical care at the end of life. We present a retrospective cohort study of 2843 patients who received a counselor-based palliative care consultation at a large US southeastern hospital. Before the palliative consultation, 72.8% of the patients had no restrictions in care, and only 4.6% had chosen care and comfort only (CCO). After the consult, these choices dramatically changed, with only 17.5% remaining full code and 43.3% choosing CCO. Both before and after palliative consultation, blacks chose more aggressive medical care than whites, but racial differences diminished after the counselor-based consultation. Both African American and white patients and families receiving a counselor-based palliative consultation in the hospital make profound changes in their preferences for life-sustaining treatments.
authors.affiliation: St. Joseph's/Candler Hospital System, Savannah, GA, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Benton
authors.affiliation: Jiann-Ping Hsu College of Public Health, Georgia Southern University, Valdosta, GA, USA.
authors.forename: James
authors.initials: J
authors.lastname: Stephens
authors.affiliation: Jiann-Ping Hsu College of Public Health, Georgia Southern University, Valdosta, GA, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Vogel
authors.affiliation: Jiann-Ping Hsu College of Public Health, Georgia Southern University, Valdosta, GA, USA.
authors.forename: Gerald
authors.initials: G
authors.lastname: Ledlow
authors.affiliation: Department of Family Medicine, Mercer University School of Medicine, Macon, GA, USA Palliative Care Service, Medical Center of Central Georgia, Macon, GA, USA ackermann.richard@mccg.org.
authors.forename: Richard
authors.initials: R
authors.lastname: Ackermann
authors.affiliation: Palliative Care Service, Medical Center of Central Georgia, Macon, GA, USA.
authors.forename: Carol
authors.initials: C
authors.lastname: Babcock
authors.affiliation: Department of Psychology, Georgia College and State University, Milledgeville, GA, USA.
authors.forename: Georgia
authors.initials: G
authors.lastname: McCook
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000523:psychology* / Q000706:statistics & numerical data; D000368:Aged; D002755:Choice Behavior; D003376:Counseling; D005260:Female; D005845:Georgia; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000523:psychology* / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D057240:Patient Preference / Q000208:ethnology*; D013727:Terminal Care / Q000523:psychology* / Q000706:statistics & numerical data; D044465:White People / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult
keywords: African Americans; hospice; mortality; palliative consultation; resuscitation; treatment preferences